Infrastructuring in Healthcare through the OpenEHR Architecture

In Norway, a national initiative is currently aiming at standardising the electronic patient record (EPR) content based on an openEHR framework. The openEHR architecture, offers users the capability to conduct standardisation and structuration of the EPR content in a distributed manner, through an internet-based tool. Systems based on this architecture, is expected to ensure universal (also internationally) interoperability among all forms of electronic data. A crude estimate is that it is necessary to define somewhere between 1000 and 2000 standardised elements or clinical concepts (so-called archetypes), to constitute a functioning EPR system. Altogether, the collection of defined archetypes constitutes a backbone of an interoperable EPR system lending on the openEHR architecture. We conceptualize the agreed-upon archetypes as a large-scale information infrastructure, and the process of developing the archetypes as a infrastructuring effort. With this as a backdrop, we focus on the following research question: What are the challenges of infrastructuring in a large-scale user-driven standardisation process in healthcare? This question is operationalized into three sub-questions: First, how are the openEHR-based archetypes standardised in practice? Second, what is the role of daily clinical practice, and existing systems in the process of developing archetypes? Third, how may related, but supposedly independent infrastructuring projects shape each other’s progress? We contribute with insight into how power relations and politics shape the infrastructuring process. Empirically, we have studied the formative process of establishing a national information infrastructure based on the openEHR approach in the period 2012–2016 in Norway.